Surprise Bills Confound Vulnerable Patients At Emergency Rooms

A new study says more than one in five emergency visits to an “in-network” hospital results in treatment by an “out-of-network” physician. That can mean costly surprise bills for patients.

Say you break your leg. Fortunately you have insurance, so you head to an emergency room that’s in your insurance network – and you think, at least when it comes to your medical bill, you’re all good.

But a new study out of Yale University finds you may not be.

“This is one of the scary parts of American medicine,” said Zack Cooper, an assistant professor of public health and economics at Yale University. “Hospitals and physicians independently negotiate with insurers over network participation. So it’s possible to have a physician inside an in-network hospital who, himself or herself, is out of network.”

“The study appropriately identifies out-of-network reimbursement as a source of dissatisfaction for all payors, providers and patients in our current healthcare system,” said Kim Warth, communications director for EmCare’s parent company, in an e-mail. “We agree with the implied recommendation – which is to advance a shared goal to reengineer the current system in a positive way.”

Cooper said he hopes his work inspires legislators to follow the lead of states like New York, which in 2014 passed a law designed to protect patients who get emergency care from surprise out-of-network bills.

He also wants to examine out-of-network surprise billing in other medical specialities – like neonatology, anesthesiology, and radiology.

“There are a lot of really complicated problems in health care that can’t be solved,” Cooper said. “This is one of these rare problems, that is incredibly devastating, that we can fix.”

This report comes from the New England News Collaborative, eight public media companies coming together to tell the story of a changing region, with support from the Corporation for Public Broadcasting.